Naturopathy

Immunotherapy - effect and application

Immunotherapy - effect and application / Naturopathy

New approaches to cancer, allergies and other diseases

Immune therapies are a relatively new approach based on targeted activation of the immune system. For example, cancer cells are to be combated with the support of the body's own defenses. Professor med. Dirk Schadendorf, Director of the Department of Dermatology, Venereology and Allergology at the University Hospital Essen and Director of the West German Tumor Center (WTZ), has answered the most important questions about immune therapies.


contents

  • New approaches to cancer, allergies and other diseases
  • How does the antibody-based treatment work??
  • What makes immunotherapy different from previous treatment approaches??
  • In which diseases is an application possible?
  • What potential do you see for the future??
  • Which antibodies have already been tested?
  • What risks exist?

How does the antibody-based treatment work??

The activation of the immune system against cancer cells has been promising for years. So-called "checkpoint inhibitors" ensure that the body's own defense cells fight the cancer. The drugs do not attack the cancer cells themselves, but intervene in the control of the immune response so-called checkpoints. A number of studies now show how successfully the immune system combats cancer cells once the right shifters are actuated by special antibodies from the laboratory: deadly tumors are rapidly shrinking, some are disappearing completely. Patients with advanced cancer and poor prognosis survive much longer than with any other therapy.

In immunotherapy, for example, cancer cells are combated with the help of the body's own defenses. (Image: psdesign1 / fotolia.com)

Hard-to-treat cancers can be attacked with immunotherapy: Oncologists are currently seeing the greatest successes in black skin cancer and lung cancer. In particular, in malignant melanoma immunotherapies are a trailblazing treatment pill, as this form of cancer is almost resistant to chemotherapeutic agents. The cancer can no longer hide from the immune cells. While chemotherapy attacks the tumor directly with cell poisons, the antibodies activate defense cells of the immune system. They can no longer be tricked by cancer. The advantage: your own immune system can detect tumor-specific changes very well. Thus, the immunotherapy is not only good for black skin cancer, but also for other tumors, which are triggered by so-called carcinogens, ie carcinogens or radiation such as alcohol and cigarette consumption or UV light. These include, for example, tumors of the lung, the bladder or kidney and in the head and neck area. External influences also damage the genetic material in the cells and lead to tumor development in these cancers.

What makes immunotherapy different from previous treatment approaches??

Immunotherapies show good treatment success in black skin cancer: In 2012, Europe's first immunotherapeutic drug was approved for this type of cancer. Other so-called "checkpoint inhibitors" followed in 2015. Immune therapies are becoming increasingly important in numerous cancers. However, the therapy form continues to play a pioneering role in the treatment of black skin cancer. Because the novel drugs make it possible for the first time that up to 50 percent of those affected respond to the treatment of malignant melanoma. This has a dramatic impact on average survival rates. Just ten years ago, just under one in 20 patients survived the next five years or more as soon as the black skin cancer metastasized. Today, the five-year survival rate is 40 to 45 percent - almost every second. For a significant proportion of patients, such a significant improvement has occurred.

The special feature of the immunotherapies: If the affected person refers to the treatment and the tumor shrinks, this benefit often lasts for years. This is a new quality in cancer therapy. While chemotherapy can also shrink many tumors, the success usually does not last as long. The immunotherapies are characterized by the fact that they do not destroy the cancer cells directly. Instead, the drugs enable the body's immune system to control the tumor itself.

Even diseases such as psoriasis or atopic dermatitis can be treated with the help of immunotherapies. (Image: komokvm / fotolia.com)

But even with inflammatory skin diseases such as psoriasis and atopic dermatitis immunotherapy currently experiencing enormous tailwind. For example, psoriasis now has more than ten different antibody therapies, all of which aim to alter the effectiveness of the immune system and combat inflammation of the skin and internal organs. In addition, psoriasis patients often have not only the visible inflammation of the skin. Frequently, vessels are also affected, changes in the brain and heart lead to an increased risk of a heart attack or stroke. Initial study results suggest that the antibodies used to treat psoriasis may be of benefit there as well.

In which diseases is an application possible?

In skin and lung cancer immunotherapy often causes miracles. The therapy does not always work. But if so, the cancer is often controlled for a long time. The first few years of use have shown that a large proportion of patients respond to them and, above all, benefit over the long term and over years.

Many other applications are currently in clinical trials. Cancer immunotherapy, for example, promises new hope for Merkel cell carcinoma, a rare but especially aggressive skin cancer. Since autumn 2017, the checkpoint inhibitor Avelumab has also been on the market in Germany for therapy. For advanced squamous cell carcinoma, a rare form of white skin cancer that spreads to the lymph nodes and organs, the approval of a new checkpoint inhibitor is expected in early 2019. But also in lung, bladder, head and neck tumors and kidney cancer immunotherapy have been introduced in recent years and established a new treatment pillar.

What potential do you see for the future??

Many patients already benefit from enormously improved treatment options today. Even if the annual therapy costs for the new drugs initially appear relatively expensive compared to old forms of therapy, the great benefit for those affected quickly becomes apparent. For the first time, the new antibodies in psoriasis give us the opportunity to heal more than 90 percent of people's skin. In older forms of therapy, on the other hand, the healing rates of the skin were at best 50 to 75 percent, which are determined by the so-called PASI Score (Psoriasis Area Severity Index), a psoriasis index. According to first studies, around seven out of ten patients respond to antibody therapy. Even with atopic dermatitis, a first drug is now approved in Germany. Especially in the case of severe disease progression we observe a clear improvement.

But how long does the therapy with the new drugs have to be? When is the right time to discontinue it, so that people with chronic illnesses such as atopic dermatitis or psoriasis can also be temporarily free of therapy? Here it is particularly important that those affected rely on expert competence. And current research is increasingly focusing on these questions and examining the long-term consequences of immunotherapies.

The Department of Dermatology at the University Hospital Essen is one of the leading research centers in the field of immunotherapy for inflammatory skin diseases and all forms of skin cancer. (Image: Catalin / fotolia.com)

Which antibodies have already been tested?

The Department of Dermatology at the University Hospital Essen is one of the leading research centers in the field of immunotherapy for inflammatory skin diseases and all forms of skin cancer. This includes a large range of courses. Currently, many study concepts are based on the good experiences in the treatment of all forms of skin cancer by so-called PD-1 antibodies. For the first time, Ipilimumab launched antibody therapy on the German market in 2011. The drug triggers an increased immune response and is used in advanced melanoma. Other drugs are about to be approved. Furthermore, a special research focus lies in the combination of immunotherapies with other treatment approaches. For example, a study in which the lung carcinoma was first irradiated and then the checkpoint inhibitor Durvalumab was used was particularly promising. The results suggest that patients in the advanced stage survive much longer, most recently leading to the approval of the PD-1L inhibitor Durvalumab in lung cancer. At a breathtaking pace, the use of antibodies is currently being tested. For more than 30 tumor types, PD-1 antibodies are in clinical trials.

In addition, one of the most important fields in the future is the combined therapy of effective targeted drugs with checkpoint blockers. Especially in patients with black skin cancer and a so-called BRAF mutation, which occurs in 40 percent of those affected, the expectation is high. The hope is that even in the case of inoperable or metastatic melanoma, up to 85 percent of the affected patients will respond to tumor therapy and benefit from therapy over the long term, thus further increasing their survival rates.

What risks exist?

The antibody therapies trigger an increased immune response and thus act at the contact point between tumor and T cell. The activation of the immune system fights the cancer cells, but it can also be directed against own, healthy cells in the body, so that sometimes severe and even life-threatening autoimmune diseases of the intestine, thyroid or other organs can occur. Overall, however, the therapy with PD-1 antibodies is very well tolerated. There are only very few cases of treatment discontinuation due to serious side effects. As with all new drugs, the risks and potential benefits of immunotherapy must also be weighed, as no reliable long-term data has been collected so far. But with response rates of up to 40 percent - especially in advanced stage melanoma patients, as well as those with inoperable, metastatic and aggressive cancers - immunotherapies are a great hope only for short-term improvement.

To the interview partner:
Professor med. Dirk Schadendorf is Director of the Department of Dermatology, Venereology and Allergology at the University Hospital Essen and Director of the West German Tumor Center (WTZ), the largest tumor center in Germany and one of the leading oncological centers of the German Cancer Aid. He is also chair of the Dermatological Oncology Working Group and currently involved in more than 30 clinical trials. For his studies on black skin cancer Prof. Schadendorf u.a. 2010 the German Cancer Award in the area "Clinical Part". One of his research interests is white and black skin cancer. Prof. Dr. In 2017, Dirk Schadendorf ranked first in the ranking of the Laborjournal, one of the most renowned science magazines, as the most cited cancer researcher in Germany - with more than 17,000 citations. Particularly outstanding is a study in which the BRAF kinase inhibitor vemurafenib was tested on patients with melanoma in a phase 3 clinical trial. In their degenerated cells, a specific mutation had previously been detected in the BRAF gene. (Fp)